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Derese A, Gebreegzhiabhere Y, Medhin G, Sirgu S, Hanlon C. Impact of depression on self-efficacy, illness perceptions and self-management among people with type 2 diabetes: A systematic review of longitudinal studies. PLoS One 2024; 19:e0302635. [PMID: 38709771 PMCID: PMC11073729 DOI: 10.1371/journal.pone.0302635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Treating comorbid depression does not always improve outcomes for people with type 2 diabetes. Evidence is lacking on potential psychological and behavioural intermediaries of the impact of depression on diabetes outcomes. OBJECTIVE To synthesise evidence on the impact of comorbid depression on self-efficacy, illness perceptions, and self-management in people with type 2 diabetes. DATA SOURCES We searched PubMed, Embase, PsycINFO, and Global Health databases from inception up to 29th March 2023. STUDY ELIGIBILITY CRITERIA Only prospective studies (cohort or intervention studies) were included, with no restrictions on language. The outcomes were self-efficacy, illness perceptions, and self-management. PARTICIPANTS People with type 2 diabetes in community or health settings. EXPOSURE Comorbid depression or depressive symptoms in people with type 2 diabetes. SYNTHESIS OF RESULTS A narrative review of heterogeneous studies. RISK OF BIAS The risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. RESULTS Twenty-five studies were included, all from high-income countries. Depression was associated with lower self-efficacy (2 studies), poor illness perception (1 study), and poor self-management practices (17 studies) in people with type 2 diabetes. In 6/7 studies, depressive symptoms predicted less adherence to dietary recommendations, 8/10 studies found depressive symptoms were associated with poor medication adherence, 1/3 study found that depressive symptoms were associated with poor weight control, 3/4 with less physical exercise, and 2/3 with general self-care practices. LIMITATIONS There were no studies from low- and middle-income countries and non-Western settings, and we cannot assume the mechanisms linking comorbid depression with diabetes outcomes are similar. CONCLUSIONS Comorbid depression was associated with lower self-efficacy, poorer self-management, and less adaptive illness perceptions among people with diabetes.
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Affiliation(s)
- Andualem Derese
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Gebreegzhiabhere
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sisay Sirgu
- Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Service and Population Research Department and WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, King’s College London, London, United Kingdom
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Alzubaidi H, Oliveira VH, Samorinha C, Mc Namara K, Shaw JE. Acculturation and glycaemic control in Arab immigrants with type 2 diabetes in Australia. Diabetologia 2024; 67:663-669. [PMID: 38214713 PMCID: PMC10904404 DOI: 10.1007/s00125-023-06081-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/21/2023] [Indexed: 01/13/2024]
Abstract
AIMS/HYPOTHESIS This study aimed to investigate acculturation's direct and mediated effects on HbA1c levels in individuals with type 2 diabetes from Arabic-speaking countries that are members of the Arab League who have emigrated to Australia. METHODS In this multicentre cross-sectional study, we recruited 382 Arabic-speaking immigrants who were born in any of the 22 countries of the Arab League and who had type 2 diabetes from different healthcare settings in Australia. HbA1c levels were retrieved from medical records. A validated self-report questionnaire was used to assess behavioural and psychosocial outcomes. Acculturation was measured using the General Acculturation Index and the Adherence to Traditional Values tool. We used structural equation modelling to test mediation hypotheses. RESULTS Participants had a mean HbA1c value of 63.9 mmol/mol (8.0%), a low acculturation level (mean±SD: 1.9±0.6; range: 1-5) and highly adhered to traditional values (mean General Acculturation Index value: 3.7±0.7; range: 1-5). Higher HbA1c was associated with lower acculturation levels (Pearson correlation coefficient [r] = -0.32, p<0.01) and higher adherence to traditional values (r=0.35, p<0.01). Self-efficacy, health literacy and self-care activities partially mediated the relationship between acculturation and HbA1c. CONCLUSIONS/INTERPRETATION Among Arab immigrants in Australia with type 2 diabetes, the degree of acculturation is related to glycaemic control, suggesting possible avenues for new interventions.
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Affiliation(s)
- Hamzah Alzubaidi
- Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates.
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
- School of Medicine, Deakin Rural Health, Deakin University Faculty of Health, Warrnambool, VIC, Australia.
| | - Vitor H Oliveira
- inED Centre for Research and Innovation in Education, School of Education, Polytechnic of Porto, Porto, Portugal
| | - Catarina Samorinha
- Research Institute for Medical and Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Kevin Mc Namara
- School of Medicine, Deakin Rural Health, Deakin University Faculty of Health, Warrnambool, VIC, Australia.
| | - Jonathan E Shaw
- Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Wu D, Shi Z, Wu C, Sun W, Jin G. Sex differences in symptom network structure of depression, anxiety, and self-efficacy among people with diabetes: a network analysis. Front Public Health 2024; 12:1368752. [PMID: 38496386 PMCID: PMC10941846 DOI: 10.3389/fpubh.2024.1368752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Aims The present study aims to explore the relations between symptoms of depression and anxiety and self-efficacy among people with diabetes. At the same time, we also examined the sex difference between network structures. Methods This study recruited 413 participants with diabetes, and they completed Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), and the Self-efficacy for Diabetes (SED). Symptom network analysis and network comparison test were used to construct and compare the depression-anxiety symptom network models of the female and male groups. Finally, we conducted flow diagrams to explore the symptoms directly or indirectly related to self-efficacy. Results The strongest edges in the depression-anxiety symptom networks are the edge between "GAD3" (Excessive worry) and "GAD4" (Trouble relaxing) and the edge between "PHQ1" (Anhedonia) and "PHQ4" (Energy) in the female and male groups, respectively. Most of the symptoms with the highest EI and bridge EI are related to worry and nervousness. Additionally, in the flow diagram of the female group, "PHQ6" (Guilt) has a high negative association with self-efficacy. Conclusion Females with diabetes are more vulnerable to depression and anxiety. Interventions targeting key symptoms in the network may be helpful in relieving the psychological problems among people with diabetes.
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Affiliation(s)
| | | | | | | | - Guoxi Jin
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Bengbu Medical University, Bengbu, China
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Duarte-Díaz A, Perestelo-Pérez L, Rivero-Santana A, Peñate W, Álvarez-Pérez Y, Ramos-García V, González-Pacheco H, Goya-Arteaga L, de Bonis-Braun M, González-Martín S, Ramallo-Fariña Y, Carrion C, Serrano-Aguilar P. The relationship between patient empowerment and related constructs, affective symptoms and quality of life in patients with type 2 diabetes: a systematic review and meta-analysis. Front Public Health 2023; 11:1118324. [PMID: 37139389 PMCID: PMC10150112 DOI: 10.3389/fpubh.2023.1118324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction The aim of this systematic review is to assess the relationship between patient empowerment and other empowerment-related constructs, and affective symptoms and quality of life in patients with type 2 diabetes. Methods A systematic review of the literature was conducted, according to the PRISMA guidelines. Studies addressing adult patients with type 2 diabetes and reporting the association between empowerment-related constructs and subjective measures of anxiety, depression and distress, as well as self-reported quality of life were included. The following electronic databases were consulted from inception to July 2022: Medline, Embase, PsycINFO, and Cochrane Library. The methodological quality of the included studies was analyzed using validated tools adapted to each study design. Meta-analyses of correlations were performed using an inverse variance restricted maximum likelihood random-effects. Results The initial search yielded 2463 references and seventy-one studies were finally included. We found a weak-to-moderate inverse association between patient empowerment-related constructs and both anxiety (r = -0.22) and depression (r = -0.29). Moreover, empowerment-related constructs were moderately negatively correlated with distress (r = -0.31) and moderately positively correlated with general quality of life (r = 0.32). Small associations between empowerment-related constructs and both mental (r = 0.23) and physical quality of life (r = 0.13) were also reported. Discussion This evidence is mostly from cross-sectional studies. High-quality prospective studies are needed not only to better understand the role of patient empowerment but to assess causal associations. The results of the study highlight the importance of patient empowerment and other empowerment-related constructs such as self-efficacy or perceived control in diabetes care. Thus, they should be considered in the design, development and implementation of effective interventions and policies aimed at improving psychosocial outcomes in patients with type 2 diabetes. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020192429, identifier CRD42020192429.
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Affiliation(s)
- Andrea Duarte-Díaz
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Department of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna, (ULL), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
- *Correspondence: Lilisbeth Perestelo-Pérez
| | - Amado Rivero-Santana
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Wenceslao Peñate
- Department of Clinical Psychology, Psychobiology and Methodology, Universidad de La Laguna, (ULL), Tenerife, Spain
| | - Yolanda Álvarez-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Himar González-Pacheco
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Libertad Goya-Arteaga
- Multiprofessional Unit of Family and Community Care of La Laguna-Norte, Tenerife, Spain
| | - Miriam de Bonis-Braun
- Multiprofessional Unit of Family and Community Care of La Laguna-Norte, Tenerife, Spain
| | | | - Yolanda Ramallo-Fariña
- Canary Islands Health Research Institute Foundation (FIISC), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
| | - Carme Carrion
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Pedro Serrano-Aguilar
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Madrid, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
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Vitality, mental health and role-physical mediate the influence of coping on depressive symptoms and self-efficacy in patients with non-alcoholic fatty liver disease: A cross-sectional study. J Psychosom Res 2022; 162:111045. [PMID: 36174369 DOI: 10.1016/j.jpsychores.2022.111045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/14/2022] [Accepted: 09/17/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Our aim was to determine whether the association between active coping and depressive symptoms in patients with non-alcoholic fatty liver disease (NAFLD) was mediated by vitality, and whether diabetes and obesity could impact on this relationship. We also wanted to find out whether mental health and role-physical modulated the relationship between passive/avoidance coping and self-efficacy, and the role of liver fibrosis. METHODS Depressive symptoms (BDI-II), self-efficacy (GSE), coping (COPE-28) and quality of life (SF-12) were evaluated in 509 biopsy-proven NAFLD patients in this cross-sectional study. Mediation and moderated mediation models were conducted using the SPSS PROCESS v3.5 macro. RESULTS Vitality mediated the relationship between active coping and depressive symptoms (-2.254, CI = -2.792 to -1.765), with diabetes (-0.043, p = 0.017) and body mass index (BMI) (-0.005, p = 0.009) moderating the association. In addition, mental health (-6.435, CI = -8.399 to -4.542) and role-physical (-1.137, CI = -2.141 to -0.315) mediated the relationship between passive/avoidance coping and self-efficacy, with fibrosis stage (0.367, p < 0.001) moderating this association. Specifically, the presence of diabetes and significant fibrosis, and a higher BMI, were associated with greater negative impact on participant depressive symptoms or self-efficacy. CONCLUSION A maladaptive coping style was associated with poorer vitality, mental health and role-physical in NAFLD patients, which along with the presence of metabolic comorbidity (diabetes and obesity) and significant fibrosis predicted more depressive symptoms or poorer self-efficacy in these patients. These results suggested incorporating emotional and cognitive evaluation and treatment in patients with NAFLD.
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Li Q, Chen Y, Välimäki M, Long Q, Yang J, Guo J. The Association Between General Self-Efficacy and Depressive Symptoms in People with Type 2 Diabetes Mellitus: The Mediating Role of Coping Styles Preference. Psychol Res Behav Manag 2022; 15:2501-2511. [PMID: 36104998 PMCID: PMC9467442 DOI: 10.2147/prbm.s381742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background Depressive symptoms are prevalent in persons with type 2 diabetes mellitus and related with poor disease outcomes. Both general self-efficacy and coping style are associated with depressive symptoms. A model about proactive coping indicates that coping style plays a mediation role between general self-efficacy and depressive symptoms. But, empirical evidence is missing about this potential mediation relationship which may be a barrier of taking precise strategies for relieving depressive symptoms. Objective This study aims to investigate the prevalence of elevated depressive symptoms in persons with type 2 diabetes mellitus and explore whether coping style preference mediates the association between general self-efficacy and depressive symptoms. Methods This was a secondary data analysis of a cross-sectional survey (June-July 2017) among 721 persons with type 2 diabetes mellitus (45.4% male and 54.6% female) aged from 22 to 96 years old. Data on general self-efficacy, coping style preference and depressive symptoms were collected using validated questionnaires in hospital setting. The mediation model was tested using the bootstrapping (K=5000) in the MPlus program version 7.4. The results were reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results The prevalence of elevated depressive symptoms was 58% (n = 418) among persons with type 2 diabetes mellitus at hospital setting. A higher level of general self-efficacy was related to less depressive symptoms via positive coping preference (p < 0.01). Discussion About two-thirds of persons with type 2 diabetes mellitus experienced elevated depressive symptoms during hospitalization. The intervention elements, including strengthening general self-efficacy and promoting positive coping, are promising to decrease their depressive symptoms.
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Affiliation(s)
- Qingting Li
- Xiangya School of Nursing, Central South University, Changsha, 410013, People's Republic of China
| | - Yao Chen
- Xiangya School of Nursing, Central South University, Changsha, 410013, People's Republic of China
| | - Maritta Välimäki
- Xiangya School of Nursing, Central South University, Changsha, 410013, People's Republic of China
| | - Qing Long
- Xiangya School of Nursing, Central South University, Changsha, 410013, People's Republic of China
| | - Jundi Yang
- School of Nursing, the University of Hong Kong, Pokfulam, 999077, People's Republic of China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, 410013, People's Republic of China
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Gao Y, Xiao J, Han Y, Ji J, Jin H, Mawen DG, Zhong Y, Lu Q, Zhuang X, Ma Q. Self-efficacy mediates the associations of diabetes distress and depressive symptoms with type 2 diabetes management and glycemic control. Gen Hosp Psychiatry 2022; 78:87-95. [PMID: 35932599 DOI: 10.1016/j.genhosppsych.2022.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adults with type 2 diabetes (T2D) often experience two common diabetes-related psychological distress: diabetes distress and depressive symptoms. Both are associated with adverse diabetes outcomes including poor self-management and glycemic control. However, diabetes distress and depressive symptoms differ in their associations with diabetes outcomes in T2D patients. OBJECTIVE This study proposes a hypothetical model to examine whether self-efficacy mediates the adverse effects of depressive symptoms and/or diabetes distress on self-care behaviors and glycemic control. Additionally, we examined the bi-directional relationships between diabetes distress and depressive symptoms to identify potential underlying mechanisms. METHODS This study conducted in 15 rural health clinics in Jiangsu province China. 900 adults with T2D participated in the prospective cohort study. The data Diabetes distress (the 17-item Diabetes Distress Scale, DDS17), depressive symptoms(the 10-item Center for Epidemiologic Studies Depression Scale, CESD-10), self-efficacy, self-care behaviors (diet and physical activity), metabolic variables (fasting plasma glucose, FPG) and demographic characteristics were assessed at baseline. Subsequent 12-month Hemoglobin A1C (HbA1c) were measured after baseline. Hierarchical multiple regression and bootstrap mediation analysis were used to test the effects and pathways among these associations. RESULTS Of 843 participants (93.67%) of total cohort with available subsequent 12-month HbA1c levels, mean age was 66.08 years and 66.55% were women, 25.15% of them had depressive symptoms (CES-D ≥ 10), 12.20% had moderate diabetes distress (mean DDS ≥2) and 4.98% had the both two psychological distress. Hierarchical multiple regression showed higher DDS score significantly predicted unhealthy diet(β = -1.10, P < 0.001) but not physical activities, while CESD score was negatively associated with physical activity (β = -0.06, P < 0.001) but not diet. No independent effects of the two psychological distress variables on subsequent 12-month HbA1c were observed. Mediation analysis supported that elevated self-efficacy solely mediated the negative effect of both diabetes distress and depressive symptoms on diet (DDS score: β = -0.238, 95 BCE% CI [-0.350, -0.141]; CESD score: β = -0.010, 95 BCE% CI [-0.016, -0.005]), physical activities (DDS score: β = -0.446, 95 BCE% CI [-0.630, -0.283]; CESD score: β = -0.019, 95 BCE% CI [-0.030, -0.010]) and subsequent 12-month HbA1c (DDS score: β = 0.105, 95 BCE% CI [0.030,0.189]; CESD score: β = 0.004, 95 BCE% CI [0.001,0.009]). Additionally, the interplay of diabetes distress and depressive symptoms exerts their effects on diabetes outcomes directly and indirectly via self-efficacy. CONCLUSIONS Self-efficacy may contribute to better diabetes outcomes and ameliorate negative effects of diabetes distress and depressive symptoms.
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Affiliation(s)
- Yuexia Gao
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China
| | - Jing Xiao
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China
| | - Yarong Han
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China
| | - Jingya Ji
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China
| | - Hui Jin
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China
| | - Dean Getrude Mawen
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China
| | - Yaqing Zhong
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China
| | - Qingyun Lu
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China
| | - Xun Zhuang
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China
| | - Qiang Ma
- Departments of Health Management, School of Public Health, Nantong University, Nantong, China; Departments of Health Management, Affiliated Hospital of Nantong University, Nantong, China.
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Lee C, Wozniak LA, Soprovich AL, Sharma V, Healy B, Samanani S, Eurich DT. Mental health experiences with COVID-19 public health measures in an Alberta First Nations Community. Int J Ment Health Syst 2022; 16:22. [PMID: 35488309 PMCID: PMC9051493 DOI: 10.1186/s13033-022-00532-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND First Nations (FN) people of Canada experience health, social, and systemic inequities due to colonization. Consequently, COVID-19 has placed further mental health stress on people related to personal finances, employment security and worry over infection, resulting in exacerbated effects of unresolved past medical and physical traumas. This study aims to understand the experiences related to mental health in an Alberta FN community during the early stages of the pandemic. METHODS In partnership with FN leadership, the study implemented an online cross-sectional survey. Adults from a large FN community in Alberta, Canada, were asked to complete a survey, including two mental health-related screening questionnaires: (1) Generalized Anxiety Disorder-2 item; and (2) Patient Health Questionnaire-2 item. In addition, respondents could provide responses to open-ended questions about their experiences. RESULTS Among 106 respondents, 95 (89.6%) finished the survey; 18% of adults screened positive for depressive symptoms (score of 3 or greater) and reported difficulty following public health advice for using hand sanitizer, maintaining social distancing, or self-isolating. 21% of adults screened positive for symptoms of anxiety (score of 3 or greater) and reported difficulty maintaining social distance, self-isolating, obtaining food and clothing, or meeting other basic living requirements. CONCLUSIONS FN communities may be disproportionately affected by COVID-19, and may experience exacerbated symptoms of anxiety, depression and overall poor mental health and well-being. Additional supports and services, including for mental health, should be considered for FN in the context of COVID-19 public health measures. HIGHLIGHTS The COVID-19 pandemic has brought upon increased stress and accompanying symptoms of anxiety and depression for a First Nations community in Alberta. Studies, such as this one, that characterize the influence of the COVID-19 pandemic on mental health among First Nations people, are urgently needed because of increasing demands on healthcare systems due to the pandemic and potential delays in the care of patients living with pre-existing mental health conditions. There is an opportunity to capitalize on First Nations people's experiences of post-traumatic growth proactively supporting/maintaining their well-being and possibly the development of community-based mental health interventions and supports.
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Affiliation(s)
- Cerina Lee
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Lisa A Wozniak
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Allison L Soprovich
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | - Vishal Sharma
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada
| | | | | | - Dean T Eurich
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation 11203-87 Avenue, Edmonton, AB, T6G 2E1, Canada.
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Baroni I, Caruso R, Dellafiore F, Ausili D, Barello S, Magon A, Conte G, Russo S, Vangone I, Guardamagna L, Arrigoni C. Self-care and type 2 diabetes mellitus (T2DM): a literature review in sex-related differences. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022277. [PMID: 36043961 PMCID: PMC9534249 DOI: 10.23750/abm.v93i4.13324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/18/2022] [Indexed: 01/26/2023]
Abstract
T2DM is a multifactorial disease, and it is considered a worldwide challenge for its increasing prevalence and its negative impact on patients' wellbeing. Even if it is known that self-care is a key factor in reaching optimal outcomes, and males and females implement different self-care behaviors, sex-related differences in self-care of patients with T2DM have been poorly investigated. Especially, an overall view of the available evidence has not yet been done. Accordingly, this review aims to summarize, critically review, and interpret the available evidence related to the sex-related differences in self-care behaviors of patients with T2DM. An extensive literature review was performed with a narrative synthesis following the PRISMA statement and flowchart through four databases: PubMed, CINAHL, Scopus, and Embase. From the 5776 identified records by the queries, only 29 articles were included, having a high-quality evaluation. Both females and males with T2DM must improve their self-care: more males reported performing better behaviors aimed at maintaining health and clinical stability (i.e., self-care maintenance) than females, but mainly in relation to physical activity. On the other hand, more females reported performing adequate behaviors aimed at monitoring their signs and symptoms (i.e., self-care monitoring) but with worse glycemic control and diabetic complications (i.e., self-care management). This review firstly provides an overall view of different self-care behaviors implemented by males and females with T2DM, showing that self-care management should be improved in both sexes. Health education must include the problems related to the diabetic pathology and the patient's own characteristics, such as sex.
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Affiliation(s)
- Irene Baroni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy, Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milano, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milano, Italy, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Serena Barello
- EngageMinds HUB – Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Milano and Cremona, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milano, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milano, Italy
| | - Sara Russo
- Nursing Degree Course, section Istituti Clinici di Pavia e Vigevano, Pavia, Italy
| | - Ida Vangone
- Department of Oncology and Hematology-Oncology, Istituto Europeo di Oncologia, Milan, Italy
| | | | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
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10
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Alzubaidi H, Sulieman H, Mc Namara K, Samorinha C, Browning C. The relationship between diabetes distress, medication taking, glycaemic control and self-management. Int J Clin Pharm 2021; 44:127-137. [PMID: 34586556 DOI: 10.1007/s11096-021-01322-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022]
Abstract
Background Diabetes distress (DD) has broad-ranging effects on type 2 diabetes (T2DM) management and outcomes. DD research is scarce among ethnic minority groups, particularly Arabic-speaking immigrant communities. To improve outcomes for these vulnerable groups, healthcare providers, including pharmacists, need to understand modifiable predictors of DD. Aim To assess and compare DD and its association with medication-taking behaviours, glycaemic control, self-management, and psychosocial factors among first-generation Arabic-speaking immigrants and English-speaking patients of Anglo-Celtic background with diabetes, and determine DD predictors. Setting Various healthcare settings in Australia. Method A multicentre cross-sectional study was conducted. Adults with T2DM completed a survey comprised of validated tools. Glycated haemoglobin, blood pressure, and lipid profile were gathered from medical records. Multiple linear regression models were computed to assess the DD predictors. Main outcome measure Diabetes distress level. Results Data was analysed for 696 participants: 56.3% Arabic-speaking immigrants and 43.7% English-speaking patients. Compared with English-speaking patients, Arabic-speaking immigrants had higher DD, lower medication adherence, worse self-management and glycaemic control, and poorer health and clinical profile. The regression analysis demonstrated that higher DD in Arabic-speaking immigrants was associated with cost-related medication underuse and lower adherence to exercise, younger age, lower education level, unemployment, lower self-efficacy, and inadequate glycaemic control. Whereas among English-speaking patients, higher DD was associated with both cost- and non-cost-related underuse of medication and lower dietary adherence. Conclusion Results provided new insights to guide healthcare providers on reducing the apparent excess burden of DD among Arabic-speaking immigrants and potentially improve medication adherence, glycaemic control, and self-management.
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Affiliation(s)
- Hamzah Alzubaidi
- Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates. .,Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates.
| | - Hana Sulieman
- Department of Mathematics and Statistics, American University of Sharjah, Sharjah, United Arab Emirates
| | - Kevin Mc Namara
- School of Medicine, Deakin University, Victoria, Australia.,Centre for Population Health Research, Deakin University, Burwood, VIC, Australia
| | - Catarina Samorinha
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
| | - Colette Browning
- School of Nursing and Healthcare Professions, Federation University, Ballarat, VIC, Australia.,Australian National University, Australian Capital Territory, Canberra, Australia
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11
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ŞAHİN D, ERSOY S, PALA E. Self-efficacy, medical adherence and related factors in patients with diabetes. FAMILY PRACTICE AND PALLIATIVE CARE 2021. [DOI: 10.22391/fppc.809768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Luo D, Zhou M, Sun L, Lin Z, Bian Q, Liu M, Ren S. Resilience as a Mediator of the Association Between Perceived Stigma and Quality of Life Among People With Inflammatory Bowel Disease. Front Psychiatry 2021; 12:709295. [PMID: 34421685 PMCID: PMC8377363 DOI: 10.3389/fpsyt.2021.709295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Improving Quality of Life (QOL) is an essential objective in the management of inflammatory bowel disease. An accumulating body of research has been conducted to explore the association between perceived stigma and QOL among patients with chronic illness. Still, underlying mechanisms behind this pathway have not been thoroughly examined. Objective: To investigate (a) the effect of perceived stigma on QOL among patients with inflammatory bowel disease; and (b) the mediating role of resilience in the association between perceived stigma and QOL. Methods: This cross-sectional study included a convenient sample of patients diagnosed with inflammatory bowel disease from four tertiary hospitals in Jiangsu Province, China. Patients completed the Perceived Stigma Scale in Inflammatory Bowel Disease (PSS-IBD), the Resilience Scale for Patients with Inflammatory Bowel Disease (RS-IBD), and the Inflammatory Bowel Disease Questionnaire (IBDQ). A bootstrapping analysis was implemented using the SPSS macro PROCESS. Results: A total of 311 patients with Cohn's disease and ulcerative colitis participated in this study, and 57.6% were men. The mean disease duration was 3.51 ± 1.04 years. Approximately 40% of the sample exceeded the criterion score for moderate stigma. Patients who perceived moderate or severe stigma reported lower QOL compared with those with mild stigma. After controlling for sociodemographic and clinical variables, we observed that perceived stigma was negatively associated with resilience. Moreover, resilience was found to mediate the relationship between perceived stigma and all aspects of QOL. Conclusions: These findings suggested that QOL of patients with inflammatory bowel disease was associated with perceived stigma and resilience and identified the mediating effects of resilience in the relationship between perceived stigma and QOL. Furthermore, this suggests that integrating intervention techniques to target resilience into the QOL improvement program of individuals with perceived stigma is possible.
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Affiliation(s)
- Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Meijing Zhou
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lifu Sun
- School of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Zheng Lin
- Department of Nursing, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,School of Nursing, Nanjing Medical University, Nanjing, China
| | - Qiugui Bian
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meihong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shurong Ren
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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13
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Lin YH, Chen DA, Lin C, Huang H. Type D Personality Is Associated with Glycemic Control and Socio-Psychological Factors on Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study. Psychol Res Behav Manag 2020; 13:373-381. [PMID: 32431557 PMCID: PMC7200262 DOI: 10.2147/prbm.s245226] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/10/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose Type D personality (TDP) has been recognized as a risk factor for many diseases. The aims of our study were to estimate the prevalence of TDP and glycemic control on the patients with type 2 diabetes mellitus (T2DM) and to assess their relationship between TDP and socio-psychological factors, such as perceived stress, self-efficacy, self-care behaviors, and psychological distress. Patients and Methods A total of 198 T2DM patients (male 62.6%, mean age 51.2±11.0, mean HbA1c 7.3±1.8%) were recruited consecutively from the Department of Endocrinology of a regional hospital in Taipei, Taiwan, from December 2017 to April 2018. They completed questionnaires that contain questions about sociodemographic characteristics, TDP, illness-related stress, self-efficacy, execution of diabetes management and emotional distress. Their medical records were reviewed for biomedical data. Results Of the 198 patients, 82 (41.4%) had TDP. Controlling for sociodemographic factors, patients with TDP were reported significantly poorer on glycemic control than those without TDP (mean HbA1c (%) 7.6±1.9 vs 7.1±1.8, P<0.05). Compared to those without TDP, the results showed significantly higher levels of perceived stress (P<0.001) and psychological distress (anxiety and depression) (P<0.001), as well as significantly lower levels of self-efficacy (P<0.001) and self-care behaviors (P<0.001) on patients with TDP. TDP was positively correlated with perceived stress and psychological distress and negatively correlated with self-efficacy and self-care behaviors scores. Discussion This study provides the evidence linking TDP with poor glycemic control, low levels of self-efficacy and self-care behaviors, as well as high levels of perceived stress and psychological distress, which highlights the screening of TDP and the tailored needs for the care among T2DM patients with TDP.
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Affiliation(s)
- Yi-Hsin Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taiwan Adventist Hospital, Taipei, Taiwan (R.O.C.)
| | - Di-An Chen
- Department of Clinic Psychology, Fu Jen Catholic University, Taipei, Taiwan (R.O.C.)
| | - Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan (R.O.C.)
| | - Hsuan Huang
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan (R.O.C.)
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14
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Hadj-Abo A, Enge S, Rose J, Kunte H, Fleischhauer M. Individual differences in impulsivity and need for cognition as potential risk or resilience factors of diabetes self-management and glycemic control. PLoS One 2020; 15:e0227995. [PMID: 31995586 PMCID: PMC6988919 DOI: 10.1371/journal.pone.0227995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/03/2020] [Indexed: 01/14/2023] Open
Abstract
Objective Impulsivity is marked by insufficient reflection and forethought, whereas Need for Cognition (NFC) also referred to as cognitive motivation or intellectual engagement is marked by elaborated thinking. The aim of this study was to investigate the potential role of these personality traits as resilience or risk factors, respectively, in diabetes self-management and glycaemic control. Further, it was examined whether diabetes-specific self-efficacy could serve as a mediator of these relationships. Design/Measures Data of 77 participants with type 2 diabetes was ascertained, using self-report instruments for NFC, impulsivity, diabetes-specific self-efficacy, and diabetes self-management. Glycemic control was assessed by the biomarker HbA1c. Results While NFC was strongly positively associated with diabetes self-management and glycemic control, impulsivity showed a reverse pattern. Results of simple and serial mediation models showed that the effects on diabetes self-management and HbA1c of both, impulsivity and NFC, were mediated by self-efficacy. Conclusion The moderate to high standardized coefficients suggests that NFC might be an important protective factor and impulsivity a possible risk factor for effective diabetes self-management and glycemic control. These traits could be applied for an easy-to-use questionnaire-based patient screening, enabling trait-tailored treatments and programs which in turn may lower economic and health costs associated with poor diabetes-care.
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Affiliation(s)
- Alexander Hadj-Abo
- Department of Psychology, Faculty of Natural Sciences, Medical School Berlin, Berlin, Germany
| | - Sören Enge
- Department of Psychology, Faculty of Natural Sciences, Medical School Berlin, Berlin, Germany
| | - Jörn Rose
- Diabetes Centrum Berlin, Berlin, Germany
| | - Hagen Kunte
- Department of Psychology, Faculty of Natural Sciences, Medical School Berlin, Berlin, Germany
| | - Monika Fleischhauer
- Department of Psychology, Faculty of Natural Sciences, Medical School Berlin, Berlin, Germany
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15
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Knowles SR, Apputhurai P, O’Brien CL, Ski CF, Thompson DR, Castle DJ. Exploring the relationships between illness perceptions, self-efficacy, coping strategies, psychological distress and quality of life in a cohort of adults with diabetes mellitus. PSYCHOL HEALTH MED 2019; 25:214-228. [DOI: 10.1080/13548506.2019.1695865] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Simon R Knowles
- Department of Psychology, Faculty of Health, Arts and Design, Swinburne University, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia
| | - Pragalathan Apputhurai
- Department of Psychology, Faculty of Health, Arts and Design, Swinburne University, Melbourne, Australia
| | - Casey L O’Brien
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia
| | - Chantal F Ski
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - David R Thompson
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - David J Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia
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16
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Khaledi M, Haghighatdoost F, Feizi A, Aminorroaya A. The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol 2019; 56:631-650. [PMID: 30903433 DOI: 10.1007/s00592-019-01295-9] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/02/2019] [Indexed: 02/06/2023]
Abstract
AIMS Depression is a common co-morbidity in patients with type 2 diabetes mellitus (T2DM). Untreated depression in these patients adversely affects self-care activities and other diabetes complications. The aim of this study is to estimate the prevalence of depression among patients with T2DM by conducting a meta-analysis of observational studies. METHODS MEDLINE, Web of Science, Science Direct, and Google Scholar databases were searched for all observational studies that assessed depression in T2DM. Relevant articles were searched using the combination of Medical Subject Heading (MeSH) terms of "depression", "depressive disorder", and "diabetes mellitus" published between January 2007 and July 2018. Random effects model was used to estimate the weighted prevalence rates and 95% CI using "metaprop program in STATA 11". RESULTS In total, the 248 included studies (with 273 reported prevalence) identified 83,020,812 participants; of them, 23,245,827 (28%; 95% CI 27, 29) suffered from different severity levels of depressive disorders. The prevalence of depression was separately reported in 137,372 males and 134,332 females. Of them, 31,396 males (23%, 95% CI: 20, 26) and 45,673 females (34%, 95% CI: 31, 38) were depressed. Compared with global estimate, depression prevalence was lower in Europe (24%) and Africa (27%), but higher in Australia (29%) and Asia (32%). The prevalence in America was equal to the estimated prevalence in the world (28%). Depression was more common in subjects younger than 65 compared with elderlies (31% vs. 21%). CONCLUSION Our findings demonstrated that almost one in four adults with T2DM experienced depression. Given the high prevalence of depressive disorders in diabetic patients, screening these patients for co-morbid depression and its relevant risk factors is highly recommended.
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Affiliation(s)
- Mohammad Khaledi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fahimeh Haghighatdoost
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ashraf Aminorroaya
- Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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17
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Naqvi JB, Helgeson VS, Gary-Webb TL, Korytkowski MT, Seltman HJ. Sex, race, and the role of relationships in diabetes health: intersectionality matters. J Behav Med 2019; 43:69-79. [PMID: 31102104 DOI: 10.1007/s10865-019-00057-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/10/2019] [Indexed: 01/05/2023]
Abstract
Previous research has seldom used an intersectionality framework to consider how sex and race affect diabetes health, nor has it examined the role of sex and race in the well-established link between romantic relationship quality and health. This study targeted 200 adults with type 2 diabetes (46% Black; 45% female) and examined whether sex, race, and the interaction between sex and race predicted behavioral and psychological health, or moderated the link between relationship quality and health outcomes. Black women reported poorer diabetes self-care and lower self-efficacy compared to other groups. Relationship quality was associated with better self-care, increased self-efficacy, and lower depressive symptoms. The association between relationship quality and medication adherence was stronger for Black women, and the association between relationship quality and self-efficacy was stronger for both Black women and White men. Results suggest that Black women with diabetes experience more health disadvantages than other groups, but some of these disadvantages might be attenuated by supportive romantic relationships.
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Affiliation(s)
- Jeanean B Naqvi
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.
| | - Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA.
| | - Tiffany L Gary-Webb
- University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Mary T Korytkowski
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA
| | - Howard J Seltman
- Department of Psychology, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, USA
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18
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Şahin TD, Göçmez SS, Eraldemir FC, Utkan T. Anxiolytic-Like and Antidepressant-Like Effects of Resveratrol in Streptozotocin-Induced Diabetic Rats. ACTA ACUST UNITED AC 2019; 56:144-149. [PMID: 31223249 DOI: 10.29399/npa.23176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 10/16/2018] [Indexed: 11/07/2022]
Abstract
Introduction Diabetes is associated with anxiety and depression. Resveratrol, one of the most potent natural polyphenols with antioxidant properties, has been demonstrated to have benefits against diabetes. In the current study, we investigated the effects of resveratrol on depression and anxiety-like behaviors in diabetic rats. Methods Adult male Wistar albino rats were assigned for control and diabetic groups, and these groups were divided into four subgroups as follows: Saline-treated, DMSO-treated, resveratrol-treated and imipramine-treated animals (n=10). Diabetes was induced by a single intraperitoneal injection of streptozotocin (STZ) (50 mg/kg), and 2 days after the STZ injection the rats having hyperglycemia (>300 mg/dl) were assigned to be diabetic. Rats in treatment groups were injected intraperitoneally with resveratrol (20 mg/kg) and imipramine (10 mg/kg) for 4 weeks. After 4-week-treatment period, tail suspension test (TST), forced swimming test (FST), elevated plus maze test (EPM) and locomotor activity test were performed. Blood samples were collected to estimate serum superoxide dismutase (SOD) and NADPH oxidase (Nox) levels. Results Diabetic rats displayed depressive-like behaviors in the FST and TST, and anxiety-like behaviors in the EPM. Resveratrol and imipramine decreased anxiety-like and depressive-like behaviors without affecting locomotor activity in diabetic rats. A significant reduction in SOD levels and a marked increase in Nox levels were observed in diabetic rats. Resveratrol treatment normalized these levels, while imipramine did not affect neither SOD nor Nox levels. Conclusion This study indicates that chronic resveratrol treatment may able to treat comorbid anxiety-and depressive-like behaviors in diabetes through inhibition of oxidative stress.
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Affiliation(s)
- Tuğçe Demirtaş Şahin
- Department of Medical Pharmacology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Semil Selcen Göçmez
- Department of Medical Pharmacology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Fatma Ceyla Eraldemir
- Department of Medical Biochemistry, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
| | - Tijen Utkan
- Department of Medical Pharmacology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey
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Azami G, Soh K, Sazlina SG, Salmiah M, Khosravi A, Aazami S, Valizadeh R. The Effect of Depression on Poor Glycemic Control in Adults with Type 2 Diabetes: The Mediating Roles of Self-Efficacy and Self-Management Behaviors. DUBAI DIABETES AND ENDOCRINOLOGY JOURNAL 2019. [DOI: 10.1159/000502126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> High levels of depression and poor self-efficacy and self-management are associated with worse glycemic control, but the linkage and pathway between these variables are poorly understood. We conducted this study to investigate the hypothesis that self-efficacy and self-management mediate the influence of depression on poor glycemic control. <b><i>Methods:</i></b> We studied a purposive sample of 142 adults with type 2 diabetes attending a public clinic in Ilam, Iran. Hierarchical linear regression analysis and structural equation modeling were used to explore the relationships among the variables of interest. <b><i>Result:</i></b> Depression directly and negatively affects self-efficacy and indirectly affects self-management behaviors, which in turn have direct effects on hemoglobin A1c (HbA1c). Self-efficacy mediates the relationship between depression and self-management behaviors. Self-efficacy and self-management behaviors partially mediate the effect of depression on HbA1c. These results confirmed that the data fit the hypothesized model very well. <b><i>Conclusion:</i></b> Careful monitoring of glycemic control might be important in those individuals who exhibit clinical signs of depression. Effective treatment programs should probably pay close attention to not only screening and treatment of depression but also skills training to enhance patient self-efficacy and self-management of diabetes to improve HbA1c.
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20
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Wild MG, Ostini R, Harrington M, Cavanaugh KL, Wallston KA. Validation of the shortened Perceived Medical Condition Self-Management Scale in patients with chronic disease. Psychol Assess 2018; 30:1300-1307. [PMID: 29781666 PMCID: PMC6172142 DOI: 10.1037/pas0000572] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Self-efficacy, or perceived competence, has been identified as an important factor in self-management behaviors and health outcomes in patients with chronic disease. Measures of self-management self-efficacy are currently available for multiple forms of chronic disease. One established measure is the 8-item Perceived Medical Condition Self-Management Scale (PMCSMS). This study investigated the use of the PMCSMS in samples of patients with a chronic disease to develop an abbreviated version of the scale that could be more readily used in clinical contexts or in large population health cohort studies. The PMCSMS was administered as either a generic scale or as a disease-specific scale. The results of analyses using item response theory and classical test theory methods indicated that using 4 items of the scale resulted in similar internal consistency (α = .70-0.90) and temporal stability (test-retest r = .75 after 2 to 4 weeks) to the 8-item PMCSMS (r = .81 after 2 to 4 weeks). The 4 items selected had the greatest discriminability among participants (α parameters = 2.49-3.47). Scores from both versions also demonstrated similar correlations with related constructs such as health literacy (r = .13-0.29 vs. 0.14-0.27), self-rated health (r = .17-0.48 vs. 0.26-0.50), social support (r = .21-0.32 vs. 0.25-0.34), and medication adherence (r = .20-0.24 vs. 0.20-0.25). The results of this study indicate that 4-item PMCSMS scores are equally valid but more efficient, and have the potential to be beneficial for both research and clinical applications. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Affiliation(s)
| | - Remo Ostini
- Rural Clinical School Research Centre, The University of Queensland
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21
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Wang D, Shi L, Li L, Guo X, Li Y, Xu Y, Yin S, Wu Q, Yang Y, Zhuang X, Gai Y, Li Q, Liu Y. Subthreshold depression among diabetes patients in Beijing: Cross-sectional associations among sociodemographic, clinical, and behavior factors. J Affect Disord 2018; 237:80-86. [PMID: 29793084 DOI: 10.1016/j.jad.2018.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 04/05/2018] [Accepted: 05/15/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND This study explores the prevalence of subthreshold depression (SubD) and its association with factors in type 2 diabetes mellitus (T2DM) patients. METHODS This cross-sectional study involved 808 outpatients with T2DM from ten hospitals in Beijing between September 2015 and January 2016. All participants completed the Patient Health Questionnaire 9-item (PHQ-9) to evaluate depressive status, with scores between 5 and 14 considered SubD. Conditional logistic regression was conducted to investigate the variables associated with SubD in T2DM patients. RESULTS T2DM patients with SubD comprised 11.6% (n = 94) of the sample. The odd ratios for the variables having significant positive associations with SubD were: being a women (OR = 1.90; 95%CI: 1.09-3.32), divorced/widowed (OR = 3.27; 95%CI: 1.46-7.30), comorbidity of cerebrovascular disease (OR = 2.00; 95%CI: 1.06-3.76), more diabetic complications (OR = 8.04; 95%CI: 2.77-23.31), and higher HbA1c in men (OR = 2.41; 95%CI: 1.25-4.64). Being older (OR = 0.78; 95%CI: 0.62-0.98), exercising more (OR = 0.44; 95%CI: 0.22-0.91) and poverty (OR = 0.36; 95%CI: 0.19-0.69) were negatively related to SubD. LIMITATIONS The sample was mainly recruited from hospital settings, which limits generalization. The study's cross-sectional design precludes making causal inferences. CONCLUSIONS The proportion of SubD was estimated to be 11.6% among T2DM patients in Beijing. Having more diabetic complications and being divorced/widowed made the odds of having SubD 8-fold and 3-fold higher than not having it, respectively. The relationship between SubD and diabetes necessitates early screening for milder forms of depression, which can alleviate the social burden and individual impairment from major depression or other chronic diseases.
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Affiliation(s)
- Dandan Wang
- Department of Endocrinology, The 306th Teaching Hospital of People's Liberation Army, Peking University, Beijing, China
| | - Lintao Shi
- Department of Endocrinology, The 306th Hospital of People's Liberation Army, Beijing, China
| | - Leling Li
- School of Public Health, Peking University, Beijing, China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, China
| | - Yufeng Li
- Department of Endocrinology and Metabolism, Pinggu Teaching Hospital, Capital Medical University, Beijing, China
| | - Yuan Xu
- Department of Endocrinology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shinan Yin
- Department of Endocrinology, The 304th Hospital of People's Liberation Army, Beijing, China
| | - Qiaozhen Wu
- Outpatient Department of Sinopec Petroleum Exploration and Production Research Institute, Beijing, China
| | - Yu Yang
- Department of Endocrinology, Huairou Hospital, Beijing, China
| | - Xiaoming Zhuang
- Department of Endocrinology, Beijing Fu Xing Hospital, Capital Medical University, Beijing, China
| | - Yingli Gai
- Outpatient Department of Beihang University, Beijing, China
| | - Quanmin Li
- Department of Endocrinology, The Rocket Force Hospital of People's Liberation Army, Beijing, China
| | - Yanjun Liu
- Department of Endocrinology, The 306th Teaching Hospital of People's Liberation Army, Peking University, Beijing, China; Department of Endocrinology, The 306th Hospital of People's Liberation Army, Beijing, China.
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22
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Indelicato L, Dauriz M, Bacchi E, Donà S, Santi L, Negri C, Cacciatori V, Bonora E, Nouwen A, Moghetti P. Sex differences in the association of psychological status with measures of physical activity and sedentary behaviour in adults with type 2 diabetes. Acta Diabetol 2018; 55:627-635. [PMID: 29582161 DOI: 10.1007/s00592-018-1132-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
AIM To assess the association of psychological variables on leisure-time physical activity and sedentary time in men and women with type 2 diabetes mellitus (T2D). METHODS In this cross-sectional study, we evaluated 163 patients with T2D, consecutively recruited at the Diabetes Centre of the Verona General Hospital. Scores on depression and anxiety symptoms, psychosocial factors (including self-efficacy, perceived interference, perceived severity, social support, misguided support behaviour, spouse's positive behaviour), physical activity and time spent sitting were ascertained using questionnaires responses to the Beck Depression Inventory-II, Beck Anxiety Inventory, Multidimensional Diabetes Questionnaire, International Physical Activity Questionnaire. RESULTS Physical activity was significantly associated with higher social support in women and with increased self-efficacy in men. Sedentary time was significantly associated with higher perceived interference, anxiety and depressive symptoms, and with reduced diabetes self-efficacy in women, while it was associated solely with anxiety in men. Depressive symptoms and self-efficacy in women and anxiety symptoms in men were independent predictors of sedentary time when entered in a multivariable regression model also including age, BMI, haemoglobin A1c, diabetes duration, perceived interference and self-efficacy as covariates. CONCLUSIONS Lower self-efficacy and higher symptoms of depression were closely associated with increased sedentary time in women, but not in men, with T2D. It is possible that individualized behavioural interventions designed to reduce depressive symptoms and to improve diabetes self-efficacy would ultimately reduce sedentary behaviours, particularly in women with T2D.
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Affiliation(s)
- Liliana Indelicato
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - Elisabetta Bacchi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Silvia Donà
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Lorenza Santi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Carlo Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Vittorio Cacciatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Arie Nouwen
- Department of Psychology, Middlesex University, London, UK
| | - Paolo Moghetti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
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23
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Schinckus L, Dangoisse F, Van den Broucke S, Mikolajczak M. When knowing is not enough: Emotional distress and depression reduce the positive effects of health literacy on diabetes self-management. PATIENT EDUCATION AND COUNSELING 2018; 101:324-330. [PMID: 28855062 DOI: 10.1016/j.pec.2017.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Adequate self-management activities are important predictors of diabetes outcomes. As diabetes literacy and self-efficacy are strong predictors of diabetes self-care, self-management education programs focus essentially on these factors. This study investigated whether emotional distress or depression moderates the relation between health literacy, self-efficacy and diabetes self-care behaviors. METHODS 128 people with type 2 diabetes were recruited in hospitals, through general practitioners and via a diabetes website, and completed a questionnaire assessing health literacy, self-efficacy, diabetes-related distress, depression and self-care behaviors. RESULTS Multiple regression analysis confirms that health literacy and self-efficacy significantly predict reported self-care behaviors. Additional regression analyses reveal that distress or depression do not predict self-care behaviors directly, but moderate the effect of health literacy, which has a weaker impact in patients experiencing distress or depression. In contrast, distress and depression do not moderate the effect of self-efficacy on diabetes self-care behaviors. CONCLUSION Emotional distress, whether related to diabetes or not, prevents patients from acting on their competence to perform adequate self-management behaviors. PRACTICE IMPLICATIONS Diabetes Professionals should pay more attention to the patients' affective state and its influence on self-care. Psychological support should be integrated in the care for people suffering from type 2 diabetes.
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Affiliation(s)
- Louise Schinckus
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium.
| | - Florence Dangoisse
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Moïra Mikolajczak
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
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24
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Góis C, Duarte TA, Paulino S, Raposo JF, do Carmo I, Barbosa A. Depressive symptoms are associated with poor glycemic control among women with type 2 diabetes mellitus. BMC Res Notes 2018; 11:38. [PMID: 29338774 PMCID: PMC5771070 DOI: 10.1186/s13104-018-3141-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/09/2018] [Indexed: 11/17/2022] Open
Abstract
Objective In patients with type 2 diabetes mellitus, depressive symptoms may be associated with metabolic deterioration. The impact of sex on this association is unclear. The aim of this study is to analyze the relationship between depression and metabolic control by sex. The data presented is the side product of the clinical investigation by Rui Duarte, MD, Treatment Response in Type 2 Diabetes Patients with Major Depression from 2007. Results A sample of 628 outpatients with type 2 diabetes mellitus was taken from a specialized diabetes outpatient clinic. In a univariate analysis: women’s glycohemoglobin mean levels were 8.99% whereas men’s were 8.41% and the difference was statistically significant. The proportion of women (34.3%) with pathological levels of depression (Hospital Anxiety Depression Scale score ≥ 8) was significantly higher than men’s (15.2%). A linear regression analysis performed by sex and controlling for demographic, clinical and psychological variables, showed poorer metabolic control in women with depressive symptoms. No association was observed in men. These results support depression as a predictor for poor metabolic control in women and the need for detecting depressive symptoms when glycemic levels deteriorate.
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Affiliation(s)
- Carlos Góis
- Serviço de Psiquiatria e Saúde Mental do Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal. .,Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal.
| | - Tiago Antunes Duarte
- Serviço de Psiquiatria e Saúde Mental do Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - Sofia Paulino
- Serviço de Psiquiatria e Saúde Mental do Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal
| | - João Filipe Raposo
- Associação Protectora dos Diabéticos de Portugal (APDP), R. Rodrigo da Fonseca 1, 1250-189, Lisbon, Portugal.,NOVA Medical School-Faculdade de Ciências Médicas, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal
| | - Isabel do Carmo
- Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - António Barbosa
- Serviço de Psiquiatria e Saúde Mental do Hospital de Santa Maria-Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-035, Lisbon, Portugal.,Faculdade de Medicina da Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
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25
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Naicker K, Manuel D, Øverland S, Skogen JC, Johnson JA, Sivertsen B, Colman I. Population attributable fractions for Type 2 diabetes: an examination of multiple risk factors including symptoms of depression and anxiety. Diabetol Metab Syndr 2018; 10:84. [PMID: 30479670 PMCID: PMC6251110 DOI: 10.1186/s13098-018-0387-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Population attributable fractions (PAFs) are frequently used to quantify the proportion of Type 2 diabetes cases due to single risk factors, an approach which may result in an overestimation of their individual contributions. This study aimed to examine Type 2 diabetes incidence associated with multiple risk factor combinations, including the metabolic syndrome, behavioural factors, and specifically, depression and anxiety. METHODS Using data from the population-based HUNT cohort, we examined incident diabetes in 36,161 Norwegian adults from 1995 to 2008. PAFs were calculated using Miettinen's case-based formula, using relative risks estimated from multivariate regression models. RESULTS Overall, the studied risk factors accounted for 50.5% of new diabetes cases (78.2% in men and 47.0% in women). Individuals exposed to both behavioural and metabolic factors were at highest risk of diabetes onset (PAF = 22.9%). Baseline anxiety and depression contributed a further 13.6% of new cases to this combination. Men appeared to be particularly vulnerable to the interaction between metabolic, behavioural and psychological risk factors. CONCLUSION This study highlights the importance of risk factor clustering in diabetes onset, and is the first that we know of to quantify the excess fraction of incident diabetes associated with psychological risk factor interactions.
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Affiliation(s)
- Kiyuri Naicker
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres., Room 308C, Ottawa, ON K1G 5Z3 Canada
| | | | - Simon Øverland
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Jens C. Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | | | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department Research and Innovation, Helse Fonna HF, Haugesund, Norway
- The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Cres., Room 308C, Ottawa, ON K1G 5Z3 Canada
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26
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Symptoms of anxiety and depression in type 2 diabetes: Associations with clinical diabetes measures and self-management outcomes in the Norwegian HUNT study. Psychoneuroendocrinology 2017; 84:116-123. [PMID: 28704763 DOI: 10.1016/j.psyneuen.2017.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/28/2017] [Accepted: 07/04/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine if symptoms of depression and anxiety are differentially associated with clinical diabetes measures and self-management behaviours in individuals with Type 2 diabetes, and whether these associations vary by patient sex. RESEARCH DESIGN AND METHODS A cross-sectional analysis using data from 2035 adults with Type 2 diabetes in the Nord-Trøndelag Health Study. Multivariate logistic regression was used to explore associations between symptoms of depression and anxiety and waist girth, HDL cholesterol, systolic blood pressure, triglycerides, c-reactive protein, glycemic control, diet adherence, exercise, glucose monitoring, foot checks for ulcers, and the subjective patient experience. Analyses were stratified by sex. RESULTS Depression was associated with a lower likelihood of avoiding saturated fats (OR=0.20 [95% CI: 0.06, 0.68]) and increased odds of physical inactivity (OR=1.69 [95% CI: 1.37, 2.72]). Anxiety was associated with increased odds of eating vegetables (OR=1.66 [95% CI: 1.02, 2.73]), and an over two-fold increase of feeling that having diabetes is difficult. In women, anxiety was associated with elevated c-reactive protein levels (OR=1.57 [95% CI: 1.05, 2.34]). In men, depressive symptoms were associated with elevated HbA1c (OR=5.00 [95% CI: 1.15, 8.23). CONCLUSIONS Symptoms of depression and anxiety were differentially associated with some key diabetes-related measures. Our results suggest sex-specific differences with respect to two important clinical outcomes (i.e., anxiety and CRP in women and depression and glycemic control in men). These findings should alert practitioners to the importance of detection and management of psychological symptoms in individuals with Type 2 diabetes.
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27
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Chew BH, Vos RC, Metzendorf M, Scholten RJPM, Rutten GEHM. Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2017; 9:CD011469. [PMID: 28954185 PMCID: PMC6483710 DOI: 10.1002/14651858.cd011469.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Many adults with type 2 diabetes mellitus (T2DM) experience a psychosocial burden and mental health problems associated with the disease. Diabetes-related distress (DRD) has distinct effects on self-care behaviours and disease control. Improving DRD in adults with T2DM could enhance psychological well-being, health-related quality of life, self-care abilities and disease control, also reducing depressive symptoms. OBJECTIVES To assess the effects of psychological interventions for diabetes-related distress in adults with T2DM. SEARCH METHODS We searched the Cochrane Library, MEDLINE, Embase, PsycINFO, CINAHL, BASE, WHO ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was December 2014 for BASE and 21 September 2016 for all other databases. SELECTION CRITERIA We included randomised controlled trials (RCTs) on the effects of psychological interventions for DRD in adults (18 years and older) with T2DM. We included trials if they compared different psychological interventions or compared a psychological intervention with usual care. Primary outcomes were DRD, health-related quality of life (HRQoL) and adverse events. Secondary outcomes were self-efficacy, glycosylated haemoglobin A1c (HbA1c), blood pressure, diabetes-related complications, all-cause mortality and socioeconomic effects. DATA COLLECTION AND ANALYSIS Two review authors independently identified publications for inclusion and extracted data. We classified interventions according to their focus on emotion, cognition or emotion-cognition. We performed random-effects meta-analyses to compute overall estimates. MAIN RESULTS We identified 30 RCTs with 9177 participants. Sixteen trials were parallel two-arm RCTs, and seven were three-arm parallel trials. There were also seven cluster-randomised trials: two had four arms, and the remaining five had two arms. The median duration of the intervention was six months (range 1 week to 24 months), and the median follow-up period was 12 months (range 0 to 12 months). The trials included a wide spectrum of interventions and were both individual- and group-based.A meta-analysis of all psychological interventions combined versus usual care showed no firm effect on DRD (standardised mean difference (SMD) -0.07; 95% CI -0.16 to 0.03; P = 0.17; 3315 participants; 12 trials; low-quality evidence), HRQoL (SMD 0.01; 95% CI -0.09 to 0.11; P = 0.87; 1932 participants; 5 trials; low-quality evidence), all-cause mortality (11 per 1000 versus 11 per 1000; risk ratio (RR) 1.01; 95% CI 0.17 to 6.03; P = 0.99; 1376 participants; 3 trials; low-quality evidence) or adverse events (17 per 1000 versus 41 per 1000; RR 2.40; 95% CI 0.78 to 7.39; P = 0.13; 438 participants; 3 trials; low-quality evidence). We saw small beneficial effects on self-efficacy and HbA1c at medium-term follow-up (6 to 12 months): on self-efficacy the SMD was 0.15 (95% CI 0.00 to 0.30; P = 0.05; 2675 participants; 6 trials; low-quality evidence) in favour of psychological interventions; on HbA1c there was a mean difference (MD) of -0.14% (95% CI -0.27 to 0.00; P = 0.05; 3165 participants; 11 trials; low-quality evidence) in favour of psychological interventions. Our included trials did not report diabetes-related complications or socioeconomic effects.Many trials were small and were at high risk of bias for incomplete outcome data as well as possible performance and detection biases in the subjective questionnaire-based outcomes assessment, and some appeared to be at risk of selective reporting. There are four trials awaiting further classification. These are parallel RCTs with cognition-focused and emotion-cognition focused interventions. There are another 18 ongoing trials, likely focusing on emotion-cognition or cognition, assessing interventions such as diabetes self-management support, telephone-based cognitive behavioural therapy, stress management and a web application for problem solving in diabetes management. Most of these trials have a community setting and are based in the USA. AUTHORS' CONCLUSIONS Low-quality evidence showed that none of the psychological interventions would improve DRD more than usual care. Low-quality evidence is available for improved self-efficacy and HbA1c after psychological interventions. This means that we are uncertain about the effects of psychological interventions on these outcomes. However, psychological interventions probably have no substantial adverse events compared to usual care. More high-quality research with emotion-focused programmes, in non-US and non-European settings and in low- and middle-income countries, is needed.
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Affiliation(s)
- Boon How Chew
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CareUniversiteitsweg 100UtrechtNetherlands3508 GA
- Faculty of Medicine and Health Sciences, Universiti Putra MalaysiaDepartment of Family MedicineSerdangSelangorMalaysia43400 UPM
| | - Rimke C Vos
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CareUniversiteitsweg 100UtrechtNetherlands3508 GA
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Rob JPM Scholten
- Julius Center for Health Sciences and Primary Care / University Medical Center UtrechtCochrane NetherlandsRoom Str. 6.126P.O. Box 85500UtrechtNetherlands3508 GA
| | - Guy EHM Rutten
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CareUniversiteitsweg 100UtrechtNetherlands3508 GA
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28
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The association between cognitive decline and incident depressive symptoms in a sample of older Puerto Rican adults with diabetes. Int Psychogeriatr 2017; 29:1317-1325. [PMID: 28511740 PMCID: PMC5527968 DOI: 10.1017/s1041610217000746] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Older Puerto Rican adults have particularly high risk of diabetes compared to the general US population. Diabetes is associated with both higher depressive symptoms and cognitive decline, but less is known about the longitudinal relationship between cognitive decline and incident depressive symptoms in those with diabetes. This study investigated the association between cognitive decline and incident depressive symptoms in older Puerto Rican adults with diabetes over a four-year period. METHODS Households across Puerto Rico were visited to identify a population-based sample of adults aged 60 years and over for the Puerto Rican Elderly: Health Conditions study (PREHCO); 680 participants with diabetes at baseline and no baseline cognitive impairment were included in analyses. Cognitive decline and depressive symptoms were measured using the Mini-Mental Cabán (MMC) and Geriatric Depression Scale (GDS), respectively. We examined predictors of incident depressive symptoms (GDS ≥ 5 at follow-up but not baseline) and cognitive decline using regression modeling. RESULTS In a covariate-adjusted logistic regression model, cognitive decline, female gender, and greater diabetes-related complications were each significantly associated with increased odds of incident depressive symptoms (p < 0.05). In a multiple regression model adjusted for covariates, incident depressive symptoms and older age were associated with greater cognitive decline, and higher education was related to less cognitive decline (p < 0.05). CONCLUSIONS Incident depressive symptoms were more common for older Puerto Ricans with diabetes who also experienced cognitive decline. Efforts are needed to optimize diabetes management and monitor for depression and cognitive decline in this population.
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29
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Indelicato L, Dauriz M, Santi L, Bonora F, Negri C, Cacciatori V, Targher G, Trento M, Bonora E. Psychological distress, self-efficacy and glycemic control in type 2 diabetes. Nutr Metab Cardiovasc Dis 2017; 27:300-306. [PMID: 28274728 DOI: 10.1016/j.numecd.2017.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 02/01/2023]
Abstract
AIM To investigate the association of glycemic control with depression, anxiety, self-efficacy and other diabetes-specific psychological measures in a cohort of adult patients with type 2 diabetes (T2D) free of severe chronic diabetes-related complications. METHODS AND RESULTS In 172 T2D outpatients consecutively recruited at the Diabetes Center of Verona City Hospital, we performed a standard medical assessment and completed the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI) and the Multidimensional Diabetes Questionnaire (MDQ) Age, body mass index (BMI) and glycosylated hemoglobin (HbA1c) were (median [IQR]): 64.0 [58.0-69.0] years, 31.0 [28.0-34.4] kg/m2, and 7.3 [6.7-8.0] %, respectively. The overall prevalence of anxiety and depression was 14.5% and 18.6%, respectively. Higher levels of HbA1c were significantly (p < 0.001) associated with a number of MDQ dimensions, such as higher perceived interference with daily activities (Spearman's rho coefficient = 0.33), higher perceived diabetes severity (rho = 0.28) and lower self-efficacy (rho = -0.27), but not with depression or anxiety. These three variables were also independent predictors of higher HbA1c levels, when entered in a multivariable stepwise-forward regression model that also included age, BMI, diabetes duration and diabetes-specific social support as covariates. CONCLUSION Lower self-efficacy and higher diabetes distress were closely associated with poorer glycemic control. No direct association between HbA1c and clinical psychological symptoms was detected. These results highlight that a number of diabetes-specific psychological variables may play a role amidst psychological distress and glycemic control. Further studies are needed to elucidate the relevance of diabetes distress and self-efficacy to the achievement of individual glycemic targets.
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Affiliation(s)
- L Indelicato
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
| | - M Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy.
| | - L Santi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - F Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - C Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - V Cacciatori
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - G Targher
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
| | - M Trento
- Laboratory of Clinical Pedagogy, Department of Medical Sciences, University of Turin, Italy
| | - E Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Hospital Trust of Verona, Verona, Italy
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30
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Naicker K, Johnson JA, Skogen JC, Manuel D, Øverland S, Sivertsen B, Colman I. Type 2 Diabetes and Comorbid Symptoms of Depression and Anxiety: Longitudinal Associations With Mortality Risk. Diabetes Care 2017; 40:352-358. [PMID: 28077458 DOI: 10.2337/dc16-2018] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/11/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Depression is strongly linked to increased mortality in individuals with type 2 diabetes. Despite high rates of co-occurring anxiety and depression, the risk of death associated with comorbid anxiety in individuals with type 2 diabetes is poorly understood. This study documented the excess mortality risk associated with symptoms of depression and/or anxiety comorbid with type 2 diabetes. RESEARCH DESIGN AND METHODS Using data for 64,177 Norwegian adults from the second wave of the Nord-Trøndelag Health Study (HUNT2), with linkage to the Norwegian Causes of Death Registry, we assessed all-cause mortality from survey participation in 1995 through to 2013. We used Cox proportional hazards models to examine mortality risk over 18 years associated with type 2 diabetes status and the presence of comorbid affective symptoms at baseline. RESULTS Three clear patterns emerged from our findings. First, mortality risk in individuals with diabetes increased in the presence of depression or anxiety, or both. Second, mortality risk was lowest for symptoms of anxiety, higher for comorbid depression-anxiety, and highest for depression. Lastly, excess mortality risk associated with depression and anxiety was observed in men with diabetes but not in women. The highest risk of death was observed in men with diabetes and symptoms of depression only (hazard ratio 3.47, 95% CI 1.96, 6.14). CONCLUSIONS This study provides evidence that symptoms of anxiety affect mortality risk in individuals with type 2 diabetes independently of symptoms of depression, in addition to attenuating the relationship between depressive symptoms and mortality in these individuals.
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Affiliation(s)
- Kiyuri Naicker
- School of Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jens C Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Douglas Manuel
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Simon Øverland
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, University Research Health, Bergen, Norway.,Department of Psychiatry, Helse Fonna HF, Haugesund, Norway
| | - Ian Colman
- School of Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
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Shao Y, Yin H, Wan C. Type D personality as a predictor of self-efficacy and social support in patients with type 2 diabetes mellitus. Neuropsychiatr Dis Treat 2017; 13:855-861. [PMID: 28360523 PMCID: PMC5365332 DOI: 10.2147/ndt.s128432] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to estimate the prevalence of Type D personality and assess the relationship between this personality type and self-efficacy/social support in Chinese patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS From January 1, 2014, to July 31, 2014, 532 consecutive patients with T2DM were recruited from two hospitals in Guangzhou, China. The participants completed questionnaires containing questions about sociodemographic characteristics, Type D personality, self-efficacy, and social support scales, and their medical records were reviewed for additional data. RESULTS Of the 532 patients, 18.2% had Type D personality. Patients with this personality type reported significantly lower levels of self-efficacy (P<0.001), total social support (P<0.001), subjective support (P<0.001), and support utilization (P=0.003), but similar level of objective support (P=0.314), compared to those of patients without Type D personality. Negative affectivity and social inhibition, two intrinsic traits of Type D personality, negatively correlated with self-efficacy and social support scores. Type D personality was significantly associated with less self-efficacy and social support (P<0.001), controlling for other sociodemographic factors. Glycosylated hemoglobin (HbA1c) levels were significantly higher in T2DM patients with Type D personality than in patients with non-Type D personality. CONCLUSION This study provides new evidence linking Type D personality with self-efficacy, social support, and poor glycemic control, highlighting the special need for care among T2DM patients with Type D personality.
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Affiliation(s)
- Yechang Shao
- School of Public Health, Southern Medical University; Department of Internal Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences
| | | | - Chengsong Wan
- Department of Microbiology, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, People's Republic of China
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Yang F, Pang JS, Cheng WJY. Self-Care Adherence and Psychological Functioning of Older Patients with Type 2 Diabetes: Effects of Persuasion, Social Pressure, and Self-Efficacy. J Clin Psychol Med Settings 2016; 23:389-401. [PMID: 27738847 DOI: 10.1007/s10880-016-9470-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This cross-sectional study examined the role of family members' use of persuasion versus pressure as distinct forms of social control by which family members attempt to encourage better diabetes management among older adults with type 2 diabetes mellitus (T2DM). The study also examined how self-efficacy might moderate the relationship between persuasion/pressure, psychological functioning, and self-care adherence. Participants were 96 men and 103 women with T2DM, with a mean age of 63.3 years. Regression results show that neither persuasion nor pressure was significantly related to self-care adherence, but persuasion and pressure were associated in complex ways with diabetes-related emotional distress and depressive symptoms for which significant interaction effects were found. Patients with lower self-efficacy benefited from persuasion, but were adversely affected by pressure. In contrast, patients with higher self-efficacy were adversely affected by persuasion, but were less negatively affected by pressure. Findings highlight the importance of reducing pressure-based social control, considering patients' self-efficacy when family members seek to influence patients' self-care behaviors, and targeting patient-family interactions in future interventions.
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Affiliation(s)
- Fang Yang
- Department of Social Work, School of Sociology and Political Science, Shanghai University, A501, 99 Shangda Road, Baoshan District, Shanghai, 200444, China.
| | - Joyce S Pang
- Division of Psychology, School of Humanities and Social Sciences, Nanyang Technological University, 14 Nanyang Drive, Singapore, 637332, Singapore
| | - Wendy J Y Cheng
- Psychological Services, INSEAD Asian Campus, 1 Ayer Rajah Avenue, Singapore, 138676, Singapore
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Alharbi M, Gallagher R, Neubeck L, Bauman A, Prebill G, Kirkness A, Randall S. Exercise barriers and the relationship to self-efficacy for exercise over 12 months of a lifestyle-change program for people with heart disease and/or diabetes. Eur J Cardiovasc Nurs 2016; 16:309-317. [PMID: 27562115 DOI: 10.1177/1474515116666475] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Barriers to exercise are common in people with coronary heart disease (CHD) and/or diabetes mellitus (DM), and may influence self-efficacy for exercise. PURPOSE The purpose of this study was to describe the exercise barriers experienced by people who have CHD and/or DM participating in the Healthy Eating and Exercise Lifestyle Program and to determine whether these barriers influence self-efficacy. METHODS Participants ( n = 134) identified their barriers to exercise and completed the self-efficacy for exercise survey at baseline, at 4 months (following structured and supervised exercise) and at 12 months (following home-based exercise with three follow-up calls). RESULTS The sample mean age was 63.6 years (SD 8.5) and 58% were male. Barriers to exercise were reported by 88% at baseline, 76% at 4 months, and 47% at 12 months. The most common barriers were lack of motivation (40.3%), lack of time overall (30.6%), and lack of time due to family commitments (17.2%). Only motivation changed significantly over time from baseline (40%) to 4 months (23%, p = 0.040). Lower self-efficacy for exercise was associated with lack of motivation at 12 months only, more depressive symptoms at baseline and 4 months, and a CHD diagnosis and higher body mass index at 12 months. In contrast, male gender and having higher self-efficacy at baseline were associated with higher self-efficacy for exercise at 4 and 12 months. CONCLUSION Patients identified many exercise barriers despite participating in a lifestyle-change program. Lack of motivation negatively influenced self-efficacy for exercise at 12 months. Other factors needing attention include baseline self-efficacy, depressive symptoms, being female, being more overweight, and having CHD.
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Affiliation(s)
- Muaddi Alharbi
- 1 Charles Perkins Centre, University of Sydney, Australia
| | | | - Lis Neubeck
- 1 Charles Perkins Centre, University of Sydney, Australia
| | - Adrian Bauman
- 1 Charles Perkins Centre, University of Sydney, Australia
| | | | | | - Sue Randall
- 4 Sydney Nursing School, University of Sydney, Australia
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Clarke J, Proudfoot J, Ma H. Mobile Phone and Web-based Cognitive Behavior Therapy for Depressive Symptoms and Mental Health Comorbidities in People Living With Diabetes: Results of a Feasibility Study. JMIR Ment Health 2016; 3:e23. [PMID: 27245948 PMCID: PMC4908303 DOI: 10.2196/mental.5131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/22/2016] [Accepted: 04/13/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Depression is often comorbid with diabetes; however, undertreatment of depressive symptoms in people affected is common. OBJECTIVE We studied preliminary acceptability and effectiveness of a fully automated, mobile phone, and web-based public health intervention, myCompass, for reducing depressive symptoms and improving mental health comorbidities in people with diabetes. METHODS In this single-group feasibility study, 89 volunteers with type 1 (n=34) or type 2 (n=55) diabetes and at least mild depressive symptoms used myCompass for 7 weeks. Web-based measures of depressive and anxious symptoms, functional impairment, diabetes-specific variables, and user satisfaction were completed at baseline, postintervention, and 3-month follow-up. RESULTS Retention rates were 54% (n=48) at postintervention and 36% (n=32) at follow-up. Depressive symptoms were significantly improved at postintervention (P<.001; within-group effect size d=1.05), with gains persisting at follow-up. Mental health comorbidities, including anxiety (P<.001), functioning (P<.001), and diabetes-specific distress (P<.001), also showed significant and sustained improvement. Satisfaction with myCompass was high, with convenience and ease of program use, and relevance of program content rated positively by participants. CONCLUSIONS The myCompass program shows promise as an acceptable and effective treatment for depression and comorbid mental health problems in people with diabetes. The program is broadly available, free to use, and may benefit patients with diabetes who do not access services and/or wish to manage their mental health themselves. Replication of these findings in a controlled study is warranted.
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Gharaibeh B, Gajewski BJ, Al-smadi A, Boyle DK. The relationships among depression, self-care agency, self-efficacy and diabetes self-care management. J Res Nurs 2016. [DOI: 10.1177/1744987115621782] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
At the time the study was conducted, Besher Gharaibeh, Byron Gajewski, and Diane Boyle were affiliated with School of Nursing University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Ahmed Al-smadi was affiliated with University of Ulster, Belfast, Newtownabbey Co. Antrim BT37 0QB, Jordandtown road, UK. The coexistence of diabetes and depression is associated with negative outcomes such as poor diabetes self-care management (DSCM). Complex relationships exist among diabetes knowledge, self-efficacy, self-care agency, depression and DSCM. No study has examined the relationships among all these factors at the same time. We aimed to examine relationships among depression, diabetes knowledge, self-care agency, self-efficacy and DSCM in insulin- treated people based on a modification of the DSCM model. A cross-sectional, correlational model testing design was used. Participants with type 1 ( n = 35) and type 2 ( n = 43) diabetes were recruited from both outpatient and community sites. Participants mean age was 46.6 years (standard deviation 13.7) and the majority were men (56.4%). Multiple regression analyses tested the hypothesised relationships. Depression was found to have a direct negative relationship with self-care agency and self-efficacy. The relationship between depression and DSCM was not direct. Self-care agency and self-efficacy completely mediated the effect of depression on DSCM. Self-efficacy completely mediated the effect of self-care agency on DSCM. We conclude that effective treatment programmes for persons managed with insulin should probably include not only screening and treatment of depression, but also skills training to enhance patient self-care agency and self-efficacy alongside DSCM.
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Affiliation(s)
- Besher Gharaibeh
- Assistant Professor, Faculty of Nursing, Jordan University of Science and Technology, Jordan
| | - Byron J Gajewski
- Professor, Department of Biostatistics, University of Kansas Medical Center, USA
| | - Ahmed Al-smadi
- Assistant Professor, Department of Basic Sciences and Humanities, American University of Madaba, Jordan
| | - Diane K Boyle
- Professor, Fay W. Whitney School of Nursing, University of Wyoming, USA
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Abstract
Depression is one of the most serious mental health comorbidities associated with diabetes. In this pilot study, we describe the associations identified via a cross-sectional survey among demographic variables, depression, self-efficacy, and glycemic control in a primarily minority population (mean age = 57.9 years; n = 30) with diabetes mellitus. Descriptive, bivariate, and correlation analyses were conducted. A significant inverse relationship was detected between depression and self-efficacy; however the relationship between depression and A1C was not significant. The implications of these findings include the need for interventions that regularly screen for depression and self-efficacy in persons diagnosed with diabetes mellitus, especially in the earlier years of diagnosis.
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Affiliation(s)
- Carla J Groh
- a University of Detroit Mercy , McAuley School of Nursing , Detroit , Michigan , USA
| | - Katherine J Moran
- a University of Detroit Mercy , McAuley School of Nursing , Detroit , Michigan , USA
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Alzubaidi H, Mc Narmara K, Kilmartin GM, Kilmartin JF, Marriott J. The relationships between illness and treatment perceptions with adherence to diabetes self-care: A comparison between Arabic-speaking migrants and Caucasian English-speaking patients. Diabetes Res Clin Pract 2015; 110:208-17. [PMID: 26415673 DOI: 10.1016/j.diabres.2015.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/03/2015] [Accepted: 08/18/2015] [Indexed: 01/22/2023]
Abstract
AIMS To compare illness and treatment perceptions between Arabic-speaking immigrants and Caucasian English-speaking people with type 2 diabetes, and explore the relationships between these beliefs and adherence to self-care activities. METHODS A cross-sectional study was conducted in healthcare settings with large Arabic populations in metropolitan and rural Victoria, Australia. Adherence to self-care activities, illness and treatment perceptions, and clinical data were recorded. Bivariate associations for continuous normally distributed variables were tested with Pearson's correlation. Non-parametric data were tested using Spearman's rank correlation coefficient. RESULTS 701 participants were recruited; 392 Arabic-speaking participants (ASPs) and 309 English-speaking participants (ESPs). There were significant relationships between participants' illness and treatment perceptions and adherence to diabetes self-care activities. ASPs' negative beliefs about diabetes were strongly and significantly correlated with poorer adherence to diet recommendations, exercise, blood glucose testing and foot care. ASPs were significantly less adherent to all aspects of diabetes self-care compared with ESPs: dietary behaviours (P=<0.01; 95% confidence interval (CI)=-1.17, -0.84), exercise and physical activity (P=<0.001, 95% CI -1.14, -0.61), blood glucose testing (P=<0.001) and foot-care (P=<0.001). 52.8% of ASPs were sceptical about prescribed diabetes treatment compared with only 11.2% of the ESPs. 88.3% of ASPs were non-adherent to prescribed medication, compared with 45.1% of ESPs. CONCLUSIONS Arabic-speaking migrants' illness and treatment perceptions were significantly different from the English-speaking group. There is a pressing need to develop new innovative interventions that deliver much-needed improvements in adherence to self-care activities and key health outcomes.
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Affiliation(s)
- Hamzah Alzubaidi
- Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia.
| | - Kevin Mc Narmara
- Greater Green Triangle University, Department of Rural Health, Flinders University and Deakin University, PO Box 423, Warrnambool, Victoria 3280, Australia; Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - Gloria M Kilmartin
- Goulburn Valley Diabetes Centre, Goulburn Valley Health, Graham St., Shepparton, Victoria 3630, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Science, Shepparton, Victoria 3630, Australia
| | - John F Kilmartin
- Goulburn Valley Diabetes Centre, Goulburn Valley Health, Graham St., Shepparton, Victoria 3630, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Science, Shepparton, Victoria 3630, Australia
| | - Jennifer Marriott
- Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
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Dzida G, Karnieli E, Svendsen AL, Sølje KS, Hermanns N. Depressive symptoms prior to and following insulin initiation in patients with type 2 diabetes mellitus: Prevalence, risk factors and effect on physician resource utilisation. Prim Care Diabetes 2015; 9:346-353. [PMID: 25649990 DOI: 10.1016/j.pcd.2015.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 11/28/2014] [Accepted: 01/06/2015] [Indexed: 01/07/2023]
Abstract
AIMS To study the frequency and intensity of depressive symptoms and associations with physician resource utilisation following insulin initiation in patients with type 2 diabetes mellitus. METHODS SOLVE was a 24-week observational study. In this sub-analysis of data from Poland, depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ)-9. RESULTS PHQ-9 was completed by 942 of 1169 patients (80.6%) at baseline, and 751 (64.2%) at both baseline and final (24-week) visit. PHQ-9 scores indicated depressive symptoms in 45.6% (n=430) at baseline, and 27.2% (n=223) at final visit. Mean PHQ-9 change was -2.38 [95% CI -2.73, -2.02], p<0.001. Depressive symptoms at baseline (OR 6.32, p<0.001), microvascular disease (OR 2.45, p=0.016), number of physician contacts (OR 1.16, p=0.009), and change in HbA1c (OR 0.60, p=0.025) were independently associated with moderate/severe depressive symptoms at final visit. Patients with more severe depressive symptoms spent more time training to self-inject (p=0.0016), self-adjust (p=0.0023) and manage other aspects of insulin delivery (p<0.0001). Patients with persistent depressive symptoms had more telephone contacts and dose changes at final visit than those without (both p<0.05). CONCLUSIONS Depressive symptoms are common with type 2 diabetes and associated with increased healthcare utilisation, reinforcing the need for holistic interdisciplinary management approaches.
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Affiliation(s)
- Grzegorz Dzida
- Department of Internal Diseases, Medical University of Lublin, Poland.
| | - Eddy Karnieli
- Endocrinology, Diabetes & Metabolism, Rambam Medical Center and Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | | | - Norbert Hermanns
- Diabetes Zentrum Mergentheim, Forschungsinstitut Diabetes-Akademie Bad Mergentheim (FIDAM GmbH), Bad Mergentheim, Germany
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Kruger J, Pollard D, Basarir H, Thokala P, Cooke D, Clark M, Bond R, Heller S, Brennan A. Incorporating Psychological Predictors of Treatment Response into Health Economic Simulation Models: A Case Study in Type 1 Diabetes. Med Decis Making 2015; 35:872-87. [PMID: 26377675 DOI: 10.1177/0272989x15590143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND . Health economic modeling has paid limited attention to the effects that patients' psychological characteristics have on the effectiveness of treatments. This case study tests 1) the feasibility of incorporating psychological prediction models of treatment response within an economic model of type 1 diabetes, 2) the potential value of providing treatment to a subgroup of patients, and 3) the cost-effectiveness of providing treatment to a subgroup of responders defined using 5 different algorithms. METHODS . Multiple linear regressions were used to investigate relationships between patients' psychological characteristics and treatment effectiveness. Two psychological prediction models were integrated with a patient-level simulation model of type 1 diabetes. Expected value of individualized care analysis was undertaken. Five different algorithms were used to provide treatment to a subgroup of predicted responders. A cost-effectiveness analysis compared using the algorithms to providing treatment to all patients. RESULTS . The psychological prediction models had low predictive power for treatment effectiveness. Expected value of individualized care results suggested that targeting education at responders could be of value. The cost-effectiveness analysis suggested, for all 5 algorithms, that providing structured education to a subgroup of predicted responders would not be cost-effective. LIMITATIONS . The psychological prediction models tested did not have sufficient predictive power to make targeting treatment cost-effective. The psychological prediction models are simple linear models of psychological behavior. Collection of data on additional covariates could potentially increase statistical power. CONCLUSIONS . By collecting data on psychological variables before an intervention, we can construct predictive models of treatment response to interventions. These predictive models can be incorporated into health economic models to investigate more complex service delivery and reimbursement strategies.
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Affiliation(s)
- Jen Kruger
- School of Health and Related Research, University of Sheffield, UK
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, UK
| | - Hasan Basarir
- School of Health and Related Research, University of Sheffield, UK
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, UK
| | - Debbie Cooke
- School of Health and Related Research, University of Sheffield, UK
| | - Marie Clark
- School of Health and Related Research, University of Sheffield, UK
| | - Rod Bond
- School of Health and Related Research, University of Sheffield, UK
| | - Simon Heller
- School of Health and Related Research, University of Sheffield, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, UK
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Gonzalez JS, Shreck E, Psaros C, Safren SA. Distress and type 2 diabetes-treatment adherence: A mediating role for perceived control. Health Psychol 2015; 34:505-13. [PMID: 25110840 PMCID: PMC4324372 DOI: 10.1037/hea0000131] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To better understand independent pathways linking emotional distress, medication adherence, and glycemic control in adults with Type 2 diabetes, as well as the potential mediating effects of perceived control over illness and self-efficacy. METHOD Adults with Type 2 diabetes (N = 142) were recruited for an intervention study evaluating cognitive-behavioral therapy for adherence and depression. Depressive symptom severity was assessed via semistructured interview. Validated self-reports assessed diabetes-related distress, perceived control over diabetes (perceived control), self-efficacy for diabetes self-management, and medication adherence. Glycemic control was evaluated by hemoglobin A1C. Only baseline data were included in correlational and linear regression analyses. RESULTS Perceived control was an important mediator of emotional distress for both medication adherence and A1C outcomes. Specifically, regression analyses demonstrated that diabetes distress, but not depression severity, was significantly related to medication adherence and A1C. Self-efficacy and perceived control were also independently associated with medication adherence and A1C. Mediation analyses demonstrated a significant indirect effect for diabetes distress and medication adherence through perceived control and self-efficacy. The relationship between distress and A1C was accounted for by an indirect effect through perceived control. CONCLUSION Results demonstrated that diabetes-related emotional distress is associated with poorer treatment adherence and glycemic control among adults with Type 2 diabetes; these relationships were partially mediated through perceived control over diabetes. Perceptions of one's personal ability to influence the course of diabetes may be important in understanding the pathway between emotional distress and poor diabetes-treatment outcomes.
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Affiliation(s)
- Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
- Diabetes Research Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY
| | - Erica Shreck
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | - Christina Psaros
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Steven A. Safren
- Behavioral Medicine Service, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Ahrari S, Mohammadpour A, Amouzeshi Z, Agha-Yousefi A. The Relationship between Cognitive Appraisal and Adherence to Medical Regimens in Type 2 Diabetic Patients. J Caring Sci 2015; 3:277-85. [PMID: 25717457 DOI: 10.5681/jcs.2014.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/06/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Non-adherence to medical regimen has remained a challenge to the medical profession as well as to social sciences. To achieve positive results, the factors negatively impacting patient adherence to medical regimens (i.e., diet, drug and exercise regimen) must be scrutinized in detail. The objective of this research was to explore the relationship between cognitive appraisal and adherence to medical regimens in type 2 diabetic patients. METHODS In this correlational study, 218 type 2 diabetes patients receiving treatment at the Diabetes Clinic affiliated with Gonabad University of Medical Sciences were selected through non-probability (convenience) sampling from April 2012 to May 2013. Two valid and reliable questionnaires of cognitive appraisal and adherence to medical regimens were completed by each patient. The data were analyzed using SPSS ver 13. RESULTS A relationship was observed between perceived cognitive and adherence to some aspects of medical regimen. Also direct relationship was observedbetween perceived cognitive in form challenge and adherence of diet in patients with diabetes. There was no statistically significant relationship between aspects of cognitive appraisal and adherence to the drug regimen. CONCLUSION The results suggest that interventions undertaken to improve adherence to medical regimen, particularly to drug regimen in patients with type 2 diabetes, should be focused on enriching cognitive appraisal. Nurses need to help patients perceive diabetes as less of a threat and in fact should empower them, so as to look upon it as more of a challenge.
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Affiliation(s)
- Shahnaz Ahrari
- Department of Paramedicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Ali Mohammadpour
- Departemant of Nursing, Faculty of Nursing & Midwifery, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Zahra Amouzeshi
- Departemant of Nursing, Faculty of Nursing & Midwifery, Birjand University of Medical Sciences, Birjand, Iran
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Tol A, Sharifirad G, Eslami A, Shojaeizadeh D, Alhani F, Tehrani MM. Analysis of some predictive factors of quality of life among type 2 diabetic patients. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2015; 4:9. [PMID: 25767820 PMCID: PMC4355823 DOI: 10.4103/2277-9531.151903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Considering the chronic nature of diabetes and its significant effect on quality of life of patients, the present study was conducted to evaluate predictors of quality of life in these patients in order to facilitate planning health promotion intervention programs. MATERIALS AND METHODS The present study was designed as a cross-sectional study on 140 type 2 diabetic patients of Om-ol-Banin Diabetes Center of Isfahan. Data collection tool was a multidimensional questionnaire including demographic and disease related data (12 items), the standard scale for diabetes distress (17 items), the standard scale for self-efficacy in diabetic patients (8 items), and standard scale for specific quality of life of diabetic patients (15 items). Collected data were evaluated by SPSS version 11.5 using the Chi-square test, Independent T-test, ANOVA, Pearson correlation and multivariate regression analysis. RESULTS Results showed that the quality of life of diabetic patients had a statistically significant correlation with diabetes distress variable (P < 0.001) and self-efficacy variable (P < 0.001). In this study R(2) (predictive power) was 0.66. Multivariate regression model indicated diabetes distress (β = -0.277, P = 0.01) and self-efficacy (β = -0.161, P < 0.001) as variables influencing adjusted self-management for other variables. CONCLUSION The result of the present study urges that in planning health promotion interventions in the field of diabetes, more attention be paid to self-efficacy and diabetes distress variables in order to improve the efficiency and effectiveness of the interventions carried out.
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Affiliation(s)
- Azar Tol
- Department of Health Education and Promotion, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Sharifirad
- Department of Health Education and Promotion, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadali Eslami
- Department of Health Education and Promotion, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davoud Shojaeizadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Alhani
- Department of Nursing, School of Medicine, Tarbiat Modaress University, Tehran, Iran
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Chew BH, Vos R, Heijmans M, Metzendorf MI, Scholten RJPM, Rutten GEHM. Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Crabtree K, Sherrer N, Rushton T, Willig A, Agne A, Shelton T, Cherrington A. Diabetes connect: African American men's preferences for a community-based diabetes management program. DIABETES EDUCATOR 2014; 41:118-26. [PMID: 25367259 DOI: 10.1177/0145721714557043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of the study is to explore African American men's perceptions of how community-based, community-health worker (CHW)-delivered diabetes interventions might best be implemented. METHODS Four 90-minute focus groups were guided by a trained moderator with a written guide to facilitate discussion on the topic of diabetes management and preferences for community-based programs. Participants were recruited from the diabetes education database at a safety-net health system in Jefferson County, AL. Two independent reviewers performed content analysis to identify major themes using an iterative, combined deductive and inductive approach. RESULTS There were 25 male participants. Mean years living with diabetes was 9.6 (range, 1-20). Participants demonstrated knowledge of self-management strategies and identified various hardships including emotional and physical manifestations of diabetes, dietary restrictions, and institutional frustrations with the health system that contributed to self-management barriers. Their preferred CHW responsibilities were to educate, hold support groups, help track daily activities, and help find resources. Potential concerns included the need for confidentiality and fears of being stereotyped. CONCLUSIONS Participants identified critical self-management strategies but endure hardships that present barriers to daily diabetes management. Preferences for community-based programs and suggested CHW responsibilities could help to overcome many of those barriers by increasing access and providing support.
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Affiliation(s)
- Krysia Crabtree
- Eastern Virginia Medical School, Norfolk, Virginia (Ms Crabtree)
| | - Nathan Sherrer
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Mr Sherrer)
| | | | - Amanda Willig
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Willig)
| | - April Agne
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Ms Agne, Dr Cherrington)
| | - Tanya Shelton
- Cooper Green Mercy Health System, Birmingham, Alabama (Mrs Shelton)
| | - Andrea Cherrington
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Ms Agne, Dr Cherrington)
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Alharbi M, Gallagher R, Kirkness A, Sibbritt D, Tofler G. Long-term outcomes from Healthy Eating and Exercise Lifestyle Program for overweight people with heart disease and diabetes. Eur J Cardiovasc Nurs 2014; 15:91-9. [PMID: 25344059 DOI: 10.1177/1474515114557222] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/07/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The benefits of exercise and weight reduction for overweight or obese people with coronary heart disease and/or diabetes mellitus are well recognised. The Healthy Eating and Exercise Lifestyle Program demonstrated these outcomes at 4 months, but longer-term outcomes are not yet reported. AIM To determine whether positive weight, body mass index, waist and exercise duration outcomes were sustained in the long term (12 months) and to identify the independent predictors of these outcomes at 4 and 12 months. METHODS Longitudinal design, combining data of all Healthy Eating and Exercise Lifestyle Program participants (intervention and wait-list control, n = 134). Participants had a body mass index between 27 and 39 kg/m(2) and had completed cardiac rehabilitation and/or diabetes education programmes. Healthy Eating and Exercise Lifestyle Program intervention included an active phase of two 1-hour group-based supervised structured exercise sessions every week for 4 months and four 90-minute group information and support sessions. The maintenance phase included one 90-minute group-based booster information session and three 15-minute goal-focused telephone follow-up calls over 8 months. RESULTS Participants had statistically significant reductions from baseline in weight, body mass index and waist circumference and improvements in exercise duration and capacity at 4 and 12 months. Time, self-efficacy, depressive symptoms and male gender were independent predictors for body mass index, waist and/or exercise duration (p < 0.05). CONCLUSION The Healthy Eating and Exercise Lifestyle Program was an effective programme to achieve and sustain weight loss and increase exercise participation over 1 year.
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Affiliation(s)
| | | | - Ann Kirkness
- North Shore Cardiovascular Education Centre, Royal North Shore Hospital, Australia
| | | | - Geoffrey Tofler
- Northern Sydney Clinical School, Royal North Shore Hospital, Australia
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Hilliard ME, Eakin MN, Borrelli B, Green A, Riekert KA. Medication beliefs mediate between depressive symptoms and medication adherence in cystic fibrosis. Health Psychol 2014; 34:496-504. [PMID: 25110847 DOI: 10.1037/hea0000136] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Depression is a known barrier to regimen adherence for chronic conditions. Despite elevated depression rates and complex regimens for people with cystic fibrosis (CF), little is known about associations between depressive symptoms and CF adherence. One possibility is that depressive symptoms distort beliefs about medications, which may influence adherence. METHOD Adolescents and adults (N = 128; mean age = 29 ± 11 years, range = 16-63, 93% Caucasian) with CF reported on depressive symptoms and medication beliefs (self-efficacy, motivation, perceived importance, and outcome expectancies related to taking medications). Medication adherence was assessed objectively through pharmacy refill data. Cross-sectional structural equation models evaluated medication beliefs as a mediator between depressive symptoms and medication adherence. RESULTS Twenty-three percent of participants exceeded clinical cutoffs for depressive symptoms. Participants took less than half of prescribed pulmonary medications (mean adherence rate = 44.4 ± 26.7%). Depressive symptoms were correlated with adherence (r = -.22, p < .05), and medication beliefs (b = -0.13, 95% CI [-0.24, -0.03]) significantly mediated this relation. Higher depressive symptoms were associated with less positive medication beliefs (b = -0.27, p < .01), which were associated with lower medication adherence (b = 0.49, p < .01). CONCLUSIONS Depressive symptoms are related to beliefs about and adherence to CF medications. Monitoring depressive symptoms and medication beliefs in routine CF care may help identify risks for nonadherence and facilitate interventions to reduce depression, adaptive medication beliefs, and ultimately improve adherence and CF management. (PsycINFO Database Record
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Affiliation(s)
- Marisa E Hilliard
- Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine
| | - Michelle N Eakin
- Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine
| | | | - Angela Green
- Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine
| | - Kristin A Riekert
- Johns Hopkins University School of Medicine, Johns Hopkins Adherence Research Center, Division of Pulmonary and Critical Care Medicine
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Wardian J, Sun F. Factors associated with diabetes-related distress: implications for diabetes self-management. SOCIAL WORK IN HEALTH CARE 2014; 53:364-381. [PMID: 24717184 PMCID: PMC4029338 DOI: 10.1080/00981389.2014.884038] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
As 7.8% of the U.S. population is affected by diabetes, health care providers are tasked with providing resources to assist patients toward self-management. Psychosocial issues have an effect on diabetes self-care. Diabetes-related distress is associated with self-management and lower A1C. This cross-sectional study seeks to understand how demographic factors, psychological orientations, support, and diabetes management behaviors predict diabetes-related distress. This study uses data from 267 adults with Type 2 diabetes. The Diabetes Distress Scale (DDS) is a 17-item scale measuring diabetes-related distress including emotional distress, physician-related distress, regimen distress, and interpersonal distress. Hierarchical regression was conducted in four stages. The final model explains 48% of the variance in DDS. Significant factors related to lower DDS were older age, lower body mass index, higher self-efficacy, higher levels of health care provider support, and a healthy diet. Findings of this study help health care providers know where to focus to reduce diabetes-related distress. Health care provider support is significant in reducing DDS. Diabetes education may want to include strategies that increase self-efficacy and assist people with diabetes to obtain a healthy weight through a more healthful diet.
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Affiliation(s)
- Jana Wardian
- a Southwest Interdisciplinary Research Center , Arizona State University , Phoenix , Arizona , USA
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Walker RJ, Smalls BL, Hernandez-Tejada MA, Campbell JA, Egede LE. Effect of diabetes self-efficacy on glycemic control, medication adherence, self-care behaviors, and quality of life in a predominantly low-income, minority population. Ethn Dis 2014; 24:349-355. [PMID: 25065078 PMCID: PMC7394238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE This study examined the effect of self-efficacy on glycemic control, self-care behaviors, and quality of life in low-income, minority adults with diabetes. METHODS Data on 378 participants were examined. Multiple linear regression assessed associations between self-efficacy, hemoglobin A1c, medication adherence, diabetes knowledge, self-care behaviors and quality of life. RESULTS Self-efficacy had modest correlations with glycemic control (r = -.250, P < .001), medication adherence (r = -.352, P < .001), diabetes knowledge (r = .118, P = .039), diet (r = .420, P < .001), exercise (r = .220, P < .001), blood sugar testing (r = .213, P < .001), foot care (r = .121, P = .032), and mental health related quality of life (r = .137, P = .017). In the regression model, self-efficacy was significantly associated with glycemic control (3 = -.104, 95% CI: -.157, -.051), medication adherence (3 = -.067, 95% CI: -.090, -.044), diet (3 = .150, 95% CI: .108, .191), exercise (-3 = 113, 95% CI: .065, .161), blood sugar testing (3 = .107, 95% CI: .049, .164) and mental health related quality of life (3 = .112, 95% CI: .051, .173). CONCLUSION Higher self-efficacy was associated with improved glycemic control, medication adherence, self-care behavior and mental health related quality of life. PRACTICE IMPLICATIONS Emphasis on self-efficacy is relevant for educational interventions developed for low-income, minority populations.
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Rasmussen NH, Smith SA, Maxson JA, Bernard ME, Cha SS, Agerter DC, Shah ND. Association of HbA1c with emotion regulation, intolerance of uncertainty, and purpose in life in type 2 diabetes mellitus. Prim Care Diabetes 2013; 7:213-221. [PMID: 23685023 DOI: 10.1016/j.pcd.2013.04.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 03/28/2013] [Accepted: 04/16/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND The extant literature lacks breadth on psychological variables associated with health outcome for type 2 diabetes mellitus (T2DM). This investigation extends the scope of psychological information by reporting on previously unpublished factors. OBJECTIVE To investigate if intolerance of uncertainty, emotion regulation, or purpose in life differentiate T2DM adults with sustained high HbA(1c) (HH) vs. sustained acceptable HbA(1c) (AH). SUBJECTS AND METHODS Cross-sectional observational study. Adult patients with diagnosed T2DM meeting inclusionary criteria for AH, HH, or a nondiabetic reference group (NDR) were randomly selected and invited to participate. Patients who consented and participated resulted in a final sample of 312 subgrouped as follows: HH (n = 108); AH (n = 98); and NDR (n = 106). Data sources included a survey, self-report questionnaires, and electronic medical record (EMR). RESULTS HH individuals with T2DM reported lower purpose in life satisfaction (p = 0.005) compared to the NDR group. The effect size for this finding is in the small-to-medium range using Cohen's guidelines for estimating clinical relevance. The HH-AH comparison on purpose in life was nonsignificant. The emotion regulation and intolerance of uncertainty comparisons across the three groups were not significant. CONCLUSIONS The present study determined that lower purpose in life satisfaction is associated with higher HbA(1c). In a T2DM patient with sustained high HbA(1c), the primary care clinician is encouraged to consider screening for purpose in life satisfaction by asking a single question such as "Do the things you do in your life seem important and worthwhile?" The patient's response will assist the clinician in determining if meaning or purpose in life distress may be interferring with diabetes self-care. If this is the case, the clinician can shift the conversation to the value of behavioral and emotional health counseling.
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Affiliation(s)
- Norman H Rasmussen
- Department of Psychiatry and Psychology, Division of Integrated Behavioral Healthcare, Mayo Clinic, Rochester, MN, USA; Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
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Abstract
Low health literacy is common among adults and is related to adverse health outcomes. It also impacts health management and one’s ability to control his or her chronic illness. The current study examined the association of health literacy and diabetes management self-efficacy with employment among 126 individuals with diabetes. No relationship was found between health literacy and employment. Diabetes-management self-efficacy was not directly related to employment but it was indirectly linked to it through physical health and lack of interference of diabetes with activities of daily living. This research suggests that strategies to improve self-efficacy may contribute to improved health and employment outcomes. Implications for rehabilitation counseling practice and research are discussed.
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